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���c��i��� ����i�����o������ <br />Clil� OF EVEREii PERMIT SEI�VICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />/ -�-�� ,3 c/�' .�` �.�°,� j�.j r !,�'t'-;:° �tr ' � `�,.<' �"' `� �` <br />PROJECT ADDRESS <br />l� Y�� �' l t-- �._ /�� �� `��. �. J�� '� � � 5 23 ��7�'�' %�L ,j'� .. � �i(� �� ��7`�e ,�.,1!- %���'�� <br />� <br />Owner Mail Address City State/Zip Phone <br />�'.E��� ��� J' �� �:� � <br />��.� �;f <br />Tenant Mail Address City State/Zip Phone <br />��}-�/ !�_ �- �< 1-� L��.� l 5� c r�S � �� <br />ElectriCal Contractof Mail Address City State/Zip Phone <br />State License Number (required) <br />�--�, <br />� �_ !�� „ '. ", �_ � , . - <br />� <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: i� l� f� ^`:> �'a; ^'-- `-� ' <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />r�:. . <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� �� <br />I hereby certify that 1 have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing thrs type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br />violate or cancel ihe provisions of any ofher state or local !aw regulating construction or the <br />performance of construction. That l am aufhorized by the owner of this property to perform the E��a,� ��.� I <br />work for which application is made and I comply with the State Confractors Law 18.27 RCW and <br />296.200 WAC. ^ � <br />1 <br />c�_v. 2� ��.�e �s-- <br />Signature <br />REVISED 08/06/2014 <br />